12 HANSON ST - BUILDING INSPECTION (2) _Q City of Salem ware
4 :
f
APPUCATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT
IAwowrAtvr-Appacw*to taovWleft aN n mr In soetiora:4 4 A4 IV, and Dr.
L AT 40CAMONI j 2 H tx u¢ a
LOCATION Et14T
OF BETS AND
BUILDING OCFKM STROM Maas sl A"
LOT
... 9UBDNL40N - LOT BLOCK SOE
L TYPE AND COST OF BUILDwe -AI appticanta complete Paris A -D
A. TYPE OF IMPROVEMOff D. PROPOSED LIRE•FOR-DEMOUTIOW USE MOST RECENT USE
1 O N.a,aSMV RaaldanY No,reekIW M
9 O AddhMn la neidln"aMr nunew of 12 p OM MMily is Q Affluewlwa.r.a�aad
hournp una addr4 I arty;.e pwt A 131 n-13 p T is ❑ a—ck ear napkua
a mae Miay FiMr wrbr
3 �LT➢�p Aaralbn(Sea Y aaoN1 - d unit _ � Q �r
4 Rapak reprcarn.rr 140 TFwwlara h.1K rtlOteL a*wMkry- 21 ❑ PrkirV OW&W
EnnnumOr of unit--'__-- a ❑ Swvtw stew repay OMW
3 C] wnwdailp R—Aft.*reaansal steer nurnbar 230 Hoepidl.irletlsatorr
of unit 41 4ddiq In Art G 13) 150 Grape
a C] MOWq(MbeWaO 24 C] Oat Drat p101e.larr
1a ❑ c.,00d za p Paefe aab
7 p %-vAuWn ay zs O SdMA xwT.d)w 0*X*0aW
17 ❑ Gar-swab M27 ❑ %Mv% ,.road.
8 IL OWNERSHIP m wWapTwa *
a jrAUM OM eta) ��«oaamti na,aofa 29 ® OV -Spw& a ac�iv�
9 O Pudic(Feden4 stt&a kcal pw wenwa rt TU✓
C. MGM TV,
Nonr" hw"-Oeerba n deW popard uaa d bddngk 04;-10W PVC09"ap Ph"
/ nrWrt a11aA b-%*v a+dm d l+a.pI . Ownwo"v edlaat e.aald.T edwaL aaaepo
1G Cow d in PMMMra — ----- a IC pradMd od'd prktia 9an9a IM dapl r- -abR rend o1Ma buo*M oat bddt
at:OLSOW wr1L a ur d eaiwiq bddrq in befrq Uwg A erwr papoeed uaa
ro a ina+a9ad bN rot YrCUabd
;n Ma above Car 3000
b. wu.,w,p.._.-._..-...__._..._..-----------------r
Od aNTC-/ W/ oTttGe-f ray, 4.,1 c•,C
a �0.ai CoMMWWV....-------- �1a OariMerator,eclW�Ioc1C�Y._ I _-- Y !/bar11. TOTAL COST OF IMPROVEMENT 7 I )
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete parts E -L,' demolition,
com to on Parts✓A M ait others ski to IV
E. PRINCIPAL TYPE OF FRAME F. PRIICPAL TYPE OF HEATNQ FUEL G. TYPE OF SEWAGE DISPOSALF;V
CHANWAL
30 ❑ Magary(wY txrnp) 73 p Gee 40 ® Ptelc a prn'ab Conipanlr cenvai r
31 `N Naod frrne 3a ❑ OI 41 Pr.M(eapt:beretda) 934 ❑ %%.tvWtM 31 Q Electr 43 p 'r
33 34 0 ReiNas d cMconcret 9 p Cabal K TYPE of wATEII SUPPLY r,ewalOrl
❑ oar-sp.c/I sp ® Pttle a pdwt.panp.nlr 47 C]
43 p Prwat(we4 6590+)
9{
F
i oerEr+srons ZI�v M. DEMOLITION OF STRUCTURES: '
a rw,rc +r of s O _
a low 94 0 far a ba+nr Has Approval from Historical Commission been received
r loud b1SW M e.twv 10 po`O for any structure over fitly(50)Years? Yes_ No—
Sa Tey eoa aroma ea FL Dig.Sit!Number .
IC rwxl6rOF OFFSTNEET PARKING SPACES Past Conizat
Si. Ercmw _.._.__.__..._____........_.___......_. ...._._
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
st okld o ._.---.._..__..----------_-_._. Yes No
L NE3D6E1ML BYLDWA OWN Wdw.
Fxforr ...._—_.__.— __.---
Electi'la
5a
Gm
Fit sewers. r�n°'Or DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
°a°"Ob veer__._._._..._. BEFORE A PERMIT CAN BE ISSUED.
...__..
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ NO.-. (N Yes,please enclose doayrfenWM from HIsL Cam)
Consamillon Area? Yea_ Now (If Yes,Please enclose Order of Conditions)
Has Fire Prevention approved and stamped pis or applications? Yee_ No-�—,
Is property located in the S.RA disWW Yee_ No-&-
Comply with Zoning? Yee_ No-L (If no,enclose Board of Appeal decision)
is lot grandlatilered? Yee_ No— (if Yea, submit documentatlon/if no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Yee— No—
Is Architectural Access Board approval required? Yes_ No- (If yee,submit documentation)
Massachusetts State Contractor License *
Oq 37 q1 l Salem Licensee ec
Home Improvement Contracts >k l TI Homeowners Exempt form (if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
1if'r Nang ldd� Vu *K,,51/841t CO.OW V" ZIP Gods 16L 46
1 E iV;� �l3 Esst>< 51 /3ev.-/6, -AAA- 019/ 979 V7
c..�er d �326
'Ric�.a 30 aveju ` Av-e. A 0141; 176 8r7 01
conwacimtil� I �»�;►>0��70�� 13 714
a �� � i�) ic�;�er�S /10 o t s7✓ cb,� AA 0ig60 97d S32
Erprtir
I hereby certify that the proposed'Mork is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authonzed agent and we agree to conform to all livable laws of Nis jurisdiction py� qon
sgnrea addr 3o Ci/ercv, f ✓� f%i /l eats
3
DO NOT WRITE BELOW THIS LINE
VL VALIDATION FOR DEwwnaerrt use Orur
BuildkV
Permit number use Gmw
Buildtrq Z D C� Fra Gnx"
Permit issued
Permit Fee $ /SZ O«wN.y Loge
CertifCaIe of Occupancy S Approved b .
Drain Tile t
Plan Review Fee f
MU
NOTES AND Data• (for department use)
S U
C S
PERMIT TO BE MAILED TO:
DATE MAILED:
Completed by.
Construction to be started by.
uc
A ZONING PLAN EXAMINERS NOTES
DISTRICT +
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN•For App kmd Use
ON
A° *� CITY OF SALEM
�"
a1' PUBLIC PROPRERTY
DEPARTMENT
.',1:11:-9c 110WASI1IN(;!0NSLIt Lf:T ♦ SAIr.t. :kl,\tiSACI It. i I
'fri.:97S-74 9595 • FAX:978-740 9846
Construction Debris Disposal Affidavit
(ie(luired for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # ___ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
l It. S 150A.
The debris will be transported by:
�. .� � a ti" I��Ste,} �; ) c �, +� Sa,.t.t z'P �4
(name of haul
The debris will be disposed of in
Cf�IT Ot�JVe-. tlR-�� wl —T-qj— 3/9)
(name of I'ac:lrty) --
(address of facility)
signature of permit applicant
(late
CITY OF SALEM
3 PUBLIC PROPRERTY
DEPARTMENT
VI.v Is I AC.vHiiS�IlvINS!R[AI# S.NI!y], A1\"\i lu gi :i:1')'.�.
It 1'sx: 9,-8.17+Z�,)84t;
Workers' Compensation Insurance Affida,it: Builders/Contractors/Electricians/Plumbers
\ )licant Information Please Print Le ibl
R W
V J111C tliustnc:, t)r .miiau.mIuJic i.lualC � �� r'r Uf � aw
Lid te,s: 3o Cl
\ yese¢I--I Ay4
City,'State/Zip: a\/] ✓MA 0141��Phone #: q 7 8E7 q1 q
Are you an employer? Check the appropriate box: Type of project (required):
,�� 4. ❑ I am a general contractor and 1 6 New construction
L L.�J t am a employer with�_ ❑
clopluyees(full and/or part-time).' have hired the sub-contractors 7. RemoJeling
?.❑ 1 :fin a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees These sub-contractors have 3. ❑ Demolition
working for me in any capacity. workers' comp. insurance. y, ❑ Building addition
[No workers' cunt insurance 5. ❑ We are a corporation and its
i� P officers have exercised their 10.0 Electrical repairs or additions
rey ui red.]
right of exemption per MGL l L❑ Plumbing repairs or additions
i.❑ 1 am a homeowner doing all work b P
myself. [No workers' comp. C. 152, $1(4), and we have no 12.0 Roof repairs
insurance required.] t employees. [No workers' 13.0 Other
comp. insurance required.]
•Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information.
' I lonicowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit anew affidavit indicating such.
K'ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I urn air employer that is providing workers'compensation insurance for ory employees. Below is the policy and job site ail
information.
Insurance Company Name:_
Policy #or Self-ins. Lie. #: i IUU -0-1;- 7L5-2- / / _0-0-7 Expiration Date:'
Job Site Address:
]Z 4AtiPiA.— ��✓Lel City/State/Zip: 6-, V7
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to Secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,5110:00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to S250.00 a Jay against the violator. Be advised that J Copy of this statement may be forwarded to the Office of
Imulig:uions of die INA fla insurance coverage ecrification.
I do hereby .y air 1'rt to the pftrs'� o/p• enulties of perjury drat the infimination provided above is true and correct
// Q"' .lfdvlk (//J Dare: //Z/Y
Ph, n q78 95-7 gIIZ
U/jiciol use only. no not n rite in this area, to be completed by Lily or town officiaL
City or Fow it: _—_—. —.---- Permit/License ------
Issuing Authority (circle one):
I. Board of Ilealth 2. Building Department J. CitvlTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:. _ — _ __---- Phone
Information and Instructions
N I:I., I uscus (icneraI Lass chapter I" requires all cnlp Ioyrt:s to pniy ide workers' compensation Ior their enipliiyees.
Pursuant to this statute, an rmplul've is dciincd as "._every person in the scry ice of another under any contract of hire.
cyliress or implied. oral or written...
An empfurrr is defined as "an individual, partnership, association, corporation or other legal entity. or any t%so or more
,,I the tioragoing cm aged in a joint ctucrprise, and including the legal representam es of a deceased employer, or the
recciycr or trustee of an individual, partnership, association or other legal entity, employing employees. However the
w.i ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dls eiling house of aauvher who employs persons to do maintenance. construction or repair work on such dwelling house
,,r on the grounds or building appurtenant thereto shall not because of'such cuiploi ntent be deemed to be an employer."
S161 chapter 152, 325C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonsvealth for any -
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
.Wditionally, %I(;L chapter 152, j25C(7) states "`'either the common weal Ih nor any of its political subdivisions shall
cuter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirenicnts of this chapter have been presented to die contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) nanie(s), address(es)and phone nuniber(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file [or future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves cte.)said person is NOT required to complete this affidavit.
The t)itice of Investigations would like to thank you in advance fiar your cooperation and should you have any questions,
please do not hesitate to give us a call
I he Department's address, telephone and fix number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Olttice of Investigations
600 Washington Street
Boston, MA 02111
_. Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
1(cykcd 5-_6-05 Fax # 617-727-7749
www.mass.gov/dia
Apr 15 08 12: 33p Burke (781 ) 599-8282 p. 2
Apr 15 08 08:29a DPOD 978-740-0404 PA
CITY OF SALE-M
,71,c iRapp,
DEPAITNIENT OF PLANNING AND
COMMUNITY DFVELOPMENT
IcmBt,xL,Ly
INNN(;�.XINDtXl IN,A Kr`
1Jmv.cw1 i'" 979 619 5685+I+AX;978 7404404
Fax
To. or �I Ke From
Z4 bb Date: tzvos
Phone., $7- T5 7— Pages: 3 mc Lose--
Re: qrt.-S % c. ft� - CC:
0 Urgent E For Review 0 Please Conuncnt 0 Please Repllv XPer
YourRe.clutir
-Comments:
Apr 15 08 12: 33p Burke (781 ) 599-8282 p. 3
Apr 15 08 08:29a DPCD 978-740-0404 p,2
'o"�''�o CITY OF SALEM, MASSACHUSETTS
BOARD OF APPEAL
a 1 20 WASHINGTON STR(.ET. 3RD FLOOR
� � 5ALEM, MASSAC4USI-TTS 01970
TELEP"U.NIE: 978- 745-9595
'g FAX; 97 8-74C 9846
KIMBERLEY DRISCOLL
MAYOR
November 1 , 200 7
Decision
City of Salem Zoning Board of Appeals ;-
Petition of Bass Wver Inc. requesting a 'Variance from the number of stoles
allowed (2 ''Vz) to allow a third floor roof deck 21A a Special Permit to modify
on avrictino nnn_rnnfnrmioa ctrnrfiirp fnr the nr nnartu Inentpd at 12 UANff1N
Apr 15 08 12: 34p Burke (781 ) 599-8282 p. 4
Apr 15 08 0831a DPCD 978-740-M4 P.1
1Z
CiTy or, SALEM
DF-PAr,.TiNfHNTOF PLANNING AND
COM-MUNiTy DEVELOPMENT
tK W: INC,IC,.'S LlL-1 +5 w::W KIASSACIU;a(-'t'ISO19-,!)
1ANV(;0oN"1'11(!AN,A1CV
Fwc
To.
Fax. 'T
Phone: S9 $ -Z— I ages; 17 ,,,r
Re: Fo,-S5 QAver CC:
0 Umnit 0 For Review 0 Please Conim-nit 0111e,,iscReply 91,cr
Your ReclucsL
-commethts:
Apr 15 08 12: 34p Burke 1781 ) 599-0282 p. 5
Apr 15 08 08:31a DPCD 978-740-0404 p.2
01&
CITY OF SALEM, 11''IASSACHUSETTS
BOARD 5 RE ET A7_120 WASHING TON S%RE ET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
TELEPHONE' 978. ?45-BS95
FAX; 978,74C 9846
KIMBERLEY DRISCOLL
MAYOR -
November 1, 200 7
Decision
City of Salem Zoning Board of Appeals
Petition of Bass 1bver Inc. requesting a Variance from the number of stor7es
allowed (2 %z) to allow a third floor roof deck air d a Special Permit to modify
an existing non-conforming structure for the pi operty located at 12 RANSON
STREET (R-21.
A public hearing on the above petition was opened on October 17, 2007 pursuant to Mass
General Law Ch. 40A, Sec. 11,with the following Zoning Board members present: Robin Stein,
Rebecca Curran, Richard Dionne,Bonnie Belair and Elizabeth Debski.
Petitioner seeks variances pursuant to Section 9-5 and a spr cial permit pursuant to Section 8-4 to
construct a third(P) floor roof deck.
The Board of Appeal, after careful consideration of the evidence presented at the public hearing,
and after thorough review of the plans and petition submiurd_makes the following findings of
fact:
1. Attorney Patrick Burke presented the petition for the property owned by Bass River
Inc. at 12 Hanson Street in the R-2 Zoning District.
2. Bass River Inc-provides mentally handicap adults with supervised work and
educational experiences. The facility at 12 Han:on Street is open Monday thin
Friday,tY7;irally between 9:00 am and 3:00 pm.
3. Bass River Inc. proposes to construct a third floor roof deck as shown on the plans
prepared by Deer Hill Architects, LLC entitled"Proposed Roof Deck",dated June S.
2007,sheets Al-A3. Said roof deck is approximately 28' x i9' and includes a
stairway bulkhead.
4. The roof deck will be used for container gardeni.rg and it will provide program
participants with the opportunity to get outside aid learn new skills. Program
participants will be supervised when using the proposed roof deck.
5. A letter of support was submitted by Lco Jodoin (8 Hanson Sc) and Mark Chesley(6
Hanson St).
6. The Building Inspector, "fhomas St. Pierre informed the Board of Appeals that the
facility is well run and he has never found any problems when doing inspections
Apr 15 08 12: 34p Burke (7811 599-8282 p. 8
Apr 15 08 08:31a DPCD 978-740-0404 p.3
On the basis of the above findings of fact and all evidence presented at the public hearing
including,but not limited to, the Plans,Documents and test.mony, the Zoning Board of Appeals
concludes as follows:
1. The petitioner may vary tite terms of the Residential Two-Family Zoning District to
enable the proposed development, which develo)ment is consistent with the intent
and purpose of the City of Salem Zoning Ordinance-
2- In permitting such change, the Board of Appeals requires certain appropriate
conditions and safeguards as noted below-
In consideration of the above, the Salem Board of Appeals N oted, five(5) in favor(Stein, Debski,
Belair,Dionne, and Curran)none(0)opposed,to grant petitioner's requests for a variance and
special permit subject to the following terms, conditions, an safeguards:
1. Petitioner shall comply with all city and state statutes, ordinances, codes and regulations.
2. All construction shall be done as per the plans and d mensions submitted to and approved
by the Building Commissioner.
3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be
strictly adhered to.
4. Petitioner shall obtain a building permit prior to beginning any construction.
5. Exterior finishes of new construction shall be in harntony with the existing structure.
G. A Certificate of Inspection is to be obtained.
7. Petitioner shall obtain approval from any of the City Boards or Commissions having
jurisdiction including,but not limited to, the Planning Board.
8. Staff of the program will supervise all non-staff use c f the 3id floor roof deck.
obin Stem,Chatr/
Salem Z,ming Board of Appeals
A COPY OF THIS U_a:ISIV N HAS BEEN PILED WITH :HE PL.AMNVN 3 BOARD AND THE CITY CLERK
Appeal from this decision,ifany,shall be made pursuact to Section 17 of the Massachusetts Genera]Laws Chapter
40A4 and shall be filed within 70 days of tiling of this decision in the office of the City Clerk.Pursuant to the
Massachusetts General Laws Chapter 40A,Section 11,the Variance or SFecia! Permit granted herein shall not take
effect until a copy of the decisdun bcaeutg the certificate of the City Clerk '.tas been filed with the Essex South
Registry of Deeds.
J